In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) published updated guidance recommending early introduction of peanut to prevent peanut allergy. The guidance recommends early introduction for all infants, with particular emphasis on those with severe atopic dermatitis or egg allergy. These infants are considered at high risk for peanut allergy and should begin to receive infant-safe peanut foods between 4 and 6 months of age. Prior to introduction of peanut-containing foods, NIAID recommends consideration of peanut-specific serum IgE testing for these high-risk infants. The NIAID guidelines on early introduction of peanut foods are aligned with those from the American Academy of Pediatrics (AAP) published in 2019 and the Dietary Guidelines for Americans 2020-2025 published in 2020 by the United States Department of Agriculture (USDA) 

A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition was published in 2021 and provides guidance from three major North American allergy societies (AAAAI, ACAAI, CS. In addition to supporting early introduction of infant-safe peanut foods, this consensus document also recommends early introduction of well-cooked egg to prevent egg allergy. 

AAAAI, ACAAI, CSACI). These societies agree on the following: 

  • There is no data indicating that introducing other allergenic foods around 6 months of age is harmful.  
  • Parents should not delay introduction of these foods once other complementary foods have been started. 
  • Maternal exclusion of common allergens during pregnancy and/or lactation as a means to prevent food allergy is not recommended.  
  • Exclusive breast-feeding is universally recommended for all mother and there is no specific association between exclusive breast-feeding and the primary prevention of any specific food allergy. 

The North American consensus guidance also recommend that both peanut and egg be introduced around 6 months of age, but not before 4 months, to prevent peanut and/or egg allergy. This guidance goes beyond recommendations provided in the Addendum guidelines for the prevention of peanut allergy in the United States.